Tuesday, December 14, 2010

So now that the Bush-appointed Federal District Court Judge has chimed in with his opinion that the Patient Protection and Affordable Care Act is unconstitutional, it seems like a good time to review some of the basic popular arguments for and against healthcare reform as it stands.

Briefly, we have heard - and Congress agreed - that we cannot have tax-payer supported universal healthcare coverage in the United States because that would amount to socialism. As a result, rather than reforming healthcare costs and cost-drivers, what Congress ended up enacting was a bill that the President signed, mandating that everyone must eventually buy into the completely capitalistic system of contracting with profit-driven health INSURANCE companies.

Now back up a second. What is the basic idea underlying capitalist health insurance? It is to collect and maintain a large reservoir of funds by having a large number of people contribute relatively small amounts of money, on a regular basis over time, into health insurance accounts controlled by capitalist corporations, most of which are euphemistically called Health Management Organizations (HMOs). This system is feasible and necessary in our capitalist economy because only a very few of us could possibly bear the financial burden of getting sick or injured and having to engage with the bloated profit-driven US medical industry, without going bankrupt every time we felt a pain or physical discomfort.

So, all subscribers pay in to those accounts which theoretically make funds available to each one when he or she gets sick or injured and needs to pay for their always-catastrophic medical expenses. These pools of money are supposed to become capital resources, which are presumedly only made available to the minority who are sick or hurt at any given time. All subscribers pay into the pool and continue to pay regularly through their time of illness and after their recovery, ad perpetuum. Whether sick or well, you never stop paying into the system that provides tons of money - unused for medical care at any given time - to the private controlling interests who primarily use the excess funds to pay their top brass outrageous salaries & bonuses and leave plenty to invest in other capitalist corporate ventures.

Universal healthcare would have provided for a tax-supported system of paying for health care that would operate according to the same basic idea as health insurance - spreading medical costs across the widest number of contributors - all US taxpayers - but it would be a radically different system than the capitalist model in that it would naturally eliminate, for one thing, the HMO & Insurance Company profit motive that insures bloated costs and removes most incentives to promote health over illness. And it would mean that the contributions to health insurance that each of us would make, could be equitably distributed, potentially reducing the individual burden we all bear to the absolute lowest possible. This is the (shudder) socialist system that was taken off the table early on in the process of formulating "healthcare reform." But it is not this type of system that was ruled unconstitutional in the Federal District Court.

What was ruled unconstitutional was the idea that our representative, elected government could legislate a requirement that capitalist, profit-driven insurance companies would have to spread the cost of subscribing to health insurance to everyone. In doing so they would accomplish the (quiver) socialist agenda item of minimizing individual costs for health insurance coverage for all of us. This is framed as a matter of infringing on our individual right to decline health insurance coverage altogether -- which we should be able to do as a free people. If we are a freedom-loving citizenry, the argument goes, how can our government force us to pay for any "product" on the free market if we individually decide that we do not want it?

Skipping over many of the inherent absurdities of this situation -- including the argument about whether insurance is a "product" or not (a product you never really get to own, sell, exchange or get any reasonable return on) -- what effect does all this have on the concept of "socialist" vs "capitalist" or "free market" spending decisions when it comes to paying the costs of healthcare?

For one thing, it may be argued that requiring everyone to subscribe to health insurance implies a certain loss of competition and control over price-fixing by insurance company moguls. Being less able to justify gouging us with outrageous rates & premiums companies would instead be compelled to undercut each others' prices to garner the greatest market share in order to stay profitable. If everyone were legally bound to find a policy that they could afford it would shift the whole paradigm around to make insurance largely a buyer's market.

But, sticking with the status quo rather than mandating that everyone subscribe to some kind of health insurance, we all still end up needing medical care at some point and it will have to be paid for somehow. So those who opt out of the insurance game will either be faced with unbearable out-of-pocket costs or they will, as now, have to rely on the limited, inferior care provided by way of public assistance, welfare, medicaid/medicare system or some other TAXPAYER-SUPPORTED system.

Doesn't that mean that all of us freedom-loving taxpayers end up paying for the healthcare of others anyway? If so, then the status quo means capitalist healthcare for those who can barely afford it (for the most part) and socialist healthcare for those who can't pay for it themselves.

Of all the disingenuous arguments we have heard against healthcare reform or even health insurance reform, then, the idea it may be unconstitutional to mandate coverage for everyone, the most insidious is this idea that our "freedom" is somehow compromised by the Patient Protection and Affordable Care Act. The politicians and their cronies who oppose this provision of the bill on the grounds they claim are unconstitutional should have the balls and integrity to put forth an alternative bill that would accomplish what will happen by repealing the mandatory coverage provision while totally dismissing universal healthcare.

That is: anyone who wishes to opt out of insurance coverage should have the absolute freedom to do so. But in the name of pure-bred free-market capitalism they will either have to pay the full cost of any medical care they may need or forego medical care altogether. No exceptions.

If universal healthcare is unconstitutional by one means or another then NO taxpayer-supported healthcare should be available to anyone. That would, of course, extend to old people, the indigent and government employees - even military personnel and veterans, judges and all elected officials. Especially members of Congress. Our taxes pay their salaries and benefits, why should we be paying for their healthcare coverage as well as our own?

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The Roots of "The Culture Wars" written November, 2008

At the 1992 Republican National Convention, Pat Buchanan lobbed the first explicit attack on modernity, officially declaring a War on Culture in America.

Seizing the RNC podium and appropriating the GOP mantel as a platform to wage his long-fantasized Culture War, Buchanan delivered a rousing speech that presumptively enlisted the support of that party under the leadership of first President Bush.

Buchanan denounced the "radical feminism" of Bill and Hillary Clinton's " agenda [that] would impose on America -- abortion on demand, a litmus test for the Supreme Court, homosexual rights, discrimination against religious schools, women in combat -- that's change, all right," he said, "But it is not the kind of change America wants. It is not the kind of change America needs. And it is not the kind of change we can tolerate in a nation that we still call God's country."

Those words may ring familiar as they were echoed anew at the 2008 Republican National Convention, because the still powerful GOP continues to be a propitious vehicle for the marauding legions of backwardness and ignorance. They may have been defeated by and large in the latest round of national elections. But, to them, this was merely a set back and we can be sure they are already regrouping for their next assault on reason.

In the current transition back to a liberal Democratic Party-led government we must not allow ourselves to become complacent, over-confident or narrowly factional in our pursuit of a progressive realization of the Constitutional promise of freedom and equality for all of us.

Recall that, even after Buchanan called on his minions to support George the First that election went to Clinton. But they were far from defeated and eight years later they came roaring back with a vengeance by the name of George W. Bush.

If anyone thinks the reactionary Religious Right will just roll over and play dead while the Obama Administration does its best to clean up the phenomenal mess Bush left in his wake...